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Case Manager, Registered Nurse – Oncology Experience Required

Job Description:

  • Work intensely as a telephonic case manager with patients and their care teams for fully and/or self-insured clients
  • Apply and interpret applicable criteria, clinical guidelines, standardized care management plans, policies, procedures, and regulatory standards
  • Assess benefits and member needs to ensure appropriate administration of benefits
  • Apply clinical judgment and strategies to reduce risk factors and barriers and address complex health and social indicators
  • Conduct assessments using information from various sources, including co-morbid and multiple diagnoses affecting functionality
  • Consult with supervisors, clinical colleagues, Medical Directors, and other programs to overcome barriers and meet goals
  • Present cases at case conferences for multidisciplinary focus and overall claim management
  • Use case management processes in compliance with regulatory and company policies and procedures
  • Use motivational interviewing to maximize member engagement and assess health status and needs
  • Identify and appropriately escalate member needs following guidelines and protocols
  • Proactively reach out to members to collaborate on and guide their care
  • Perform medical necessity reviews

Requirements:

  • 5+ years’ experience as a Registered Nurse, including at least 1 year in a hospital setting
  • Active multistate RN license through the Nurse Licensure Compact (NLC) for nurses residing in compact states, or individual state-specific RN licenses for each supported state for nurses in non-compact states
  • 1+ years’ experience documenting electronically using a keyboard
  • 1+ years’ current or previous experience in Oncology
  • Diploma or Associates Degree in Nursing required
  • 1+ years’ Case Management, discharge planning, nurse navigator, or nurse care coordinator experience preferred
  • Experience transferring patients to lower levels of care preferred
  • 1+ years’ experience in Utilization Review preferred
  • CCM and/or other URAC recognized accreditation preferred
  • 1+ years’ experience with MCG, NCCN and/or Lexicomp preferred
  • Bilingual in Spanish preferred
  • BSN preferred

Benefits:

  • Medical coverage
  • Dental coverage
  • Vision coverage
  • Paid time off
  • Retirement savings options
  • Wellness programs
  • Other resources supporting physical, emotional, and financial well-being
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